JOINT ACTION

September 01, 2016

Osteoarthritis is a bone-joint disorder. In a purely literal sense, it simply means inflammation of one or more joints. Here is everything you wanted to know about the disorder, but did not ask…

There are many forms, or types, of arthritis. It is estimated that there are over one hundred or more types of arthritis, and the list seems to be growing every day. The forms range from those related to the so-called ‘wear and tear’ of cartilage — such as osteoarthritis [OA] — to those associated with rheumatoid arthritis [RA] — a classical auto-immune disorder.

Put together, arthritis, in its varied forms, is understood to be the most common chronic illness. Studies estimate that over 350 million people worldwide are afflicted by the disorder. Millions in India suffer from the disorder, as also the US. It is said that over 8 million in the United Kingdom alone are reported to have the disease. Experts opine that arthritis can affect anyone at any point in time.

The causes of arthritis depend on the form of disorder. They include —

Injury, which often leads to osteoarthritis

Abnormal metabolism, which leads to disorders such as gout [an inherited joint disorder]

Symptoms of arthritis include pain and limited function of the joints. Inflammation of the joints is, essentially, a characteristic feature of arthritis, followed by joint stiffness, swelling, redness, and a feeling of warmth in the affected area. Tenderness [or, sensitivity to touch] of the inflamed joint may also be present.

Most forms of arthritis — since they are classified as rheumatic disease — can involve symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms, in some patients, with arthritis can also include non-specific fever, weight loss, fatigue, and feeling of sickness.

OA does not have a bias — it affects both men and women equally. It affects children too. It is also estimated that more than half of the patients afflicted with arthritis are below 65 years of age — with approximately 60 per cent of them being women.

THE JOINTS

Normal joint function, which is engineered to provide flexibility, support, stability, and protection, is essential for appropriate and painless movement. Joints are primarily supplied by specific parts: the synovium and cartilage. The synovium is a membrane that surrounds the entire joint. It is filled with synovial fluid, a lubricating liquid, which supplies nutrients and oxygen to the cartilage. Cartilage is one of the few tissues in the body that does not have its own blood supply. It has a number of essential components, such as chondrocytes, which are, in essence, the basic cartilage cells and vital for balance and function.

Proteoglycans are another important element. Proteoglycans are large molecules that help build cartilage. Their key value is related to their capacity to ‘bond’ with water. This makes sure that there is a high-fluid content in the cartilage. Collagen is a critical protein in cartilage. It forms a web — to give support and plasticity to the joint. Collagen is, indeed, the main protein found in all the connective tissues of the body, including the muscles, ligaments, and tendons. It is the combination of the collagen meshwork and high water content that creates a springy and smooth pad in the joint — a fascinating framework, or cushion-pad, that resists the compression between bones during muscle movement.

OSTEOARTHRITIS

Osteoarthritis is the most common form of arthritis. It results from a combination of genetic abnormalities and joint injuries. In the condition, the affected joint experiences a progressive loss of cartilage. Slowly, the bone beneath the cartilage undergoes changes and forms a bony overgrowth [spur]. When the tissue that lines the joint becomes inflamed, the ligaments loosen, and the associated muscles flag, the victim experiences pain. The pain is more pronounced when the joint is used.

DEVELOPMENT OF OSTEOARTHRITIS

Osteoarthritis develops when the cartilage in a joint deteriorates. The process is usually slow. In the early stages of the disorder, the surface of the cartilage, or the synovium, becomes inflamed and swollen. Add to this the collapse of proteoglycans and other tissue components that lead to water loss, and you have fissures, or pits, in the cartilage.

When the disorder progresses and additional tissue is lost, the cartilage is deprived of its celebrated elasticity and fluid content. Result: it becomes increasingly exposed to damage due to repetitive use and/or due to injury. Soon enough, and bit by bit, large amounts of cartilage are damaged, leaving the ends of the bone within the joint open to ‘attack.’

Since the bone around the arthritic joints is not structurally normal, problems are also most likely to develop as the body attempts to repair the damage caused to the cartilage. You now have clusters of damaged cells, or fluid-filled cysts, forming around the bony areas, or near the fissures. Besides this, fluid pockets may form within the bone marrow itself, causing that typical bulge. The marrow, in the centre of bone, is rich in nerve fibres. Hence, sensitive — this explains why injuries can be a significant source of pain in most osteoarthritis patients.

It is exactly in such a situation that the body’s famous defence mechanisms come into play. As the bone cells respond to damage by multiplying, growing and forming thick, distorted plates around exposed areas, they produce outcroppings at the margins of the joint on which chondrocytes [new cartilage cells] propagate and grow abnormally.

OA, unlike rheumatoid arthritis, is not systemic — it does not spread through the entire body. Rather, it concentrates in one or several joints where deterioration occurs. The disorder affects joints differently depending on their location in the body. OA is commonly found in the joints of the fingers, feet, knees, hips, and spine. It may also affect the wrist, elbows, shoulders, and the jaw.

DIAGNOSIS

When you meet your family doctor, a review of your history of symptoms is done. The doctor also examines your joints for inflammation or deformity, and asks questions, and, thereafter, inspects other parts of the body for inflammation, or signs of disease — because the disorder can affect other body areas. In addition, your doctor may order certain blood, urine, joint fluid and/or sophisticated X-ray, and other, tests to be done. As a matter of routine, the diagnosis of the disorder is based on the pattern of symptoms, the distribution of the inflamed joints, and demonstrable blood and X-ray findings. However, you would need to visit your doctor a few times, or more, before a diagnosis can be made, or arrived at, with a full degree of certainty. It is also possible for your doctor to refer you to a specialist — a rheumatologist — trained in arthritis and other related diseases.

LIVING WITH OSTEOARTHRITIS

Exercise affected joints gently — preferably in water

Massage at and around affected joints — it’s better to seek the services of a trained therapist

A heating pad, or a damp and warm towel, may be applied on the affected joint/s

It’s ideal to maintain appropriate weight, so you do not place extra stress on the joints

You may use special equipment like cane, crutches, walker, neck collar, or elastic knee support to protect the joints from overuse. Some clinicians recommend the use of a fixed seat placed in the bathtub. This enables less stretching

Well-supported shoes, especially special shoes, are ideal foot wear.

While most forms of OA are more annoying than grave, millions of patients suffer daily with pain and disability from OA, or its complications. This not only leads to emotional and physical stress in patients, but it also affects their activity and workplace productivity.

It goes without saying that early and accurate diagnosis can help prevent permanent damage and disability. In addition, properly guided programmes of exercise and rest, medications, physical therapy, and surgical options can all bring long-term, and better, outcomes for OA patients.

The onset of osteoarthritis, as you know, is slow. It is characteristically marked by morning stiffness, crackling in the joints and some pain. When it progresses, the disorder can cause discomfort, pain and disability in varying degrees and also intensity.

However, the silver lining is — there are better and more effective treatments for OA now available.

TREATMENT

Treatment avenues include conventional medications and pharmaceutical specialities, besides alternative/Ayurveda and ancient herbal remedies and, most importantly, nutritional, or nutraceutical, supplements, such as glucosamine and chondroitin.

In realistic terms, the two nutritional supplements — glucosamine and chondroitin — are a major advance. They do not merely provide symptomatic pain relief, but they also, coincidentally, reverse the degenerative process of the disease, which medications cannot.

GLUCOSAMINE & CHONDROITIN: HEALING BY DESIGN

Nature has endowed our body to manufacture its own glucosamine, an amino acid — however, in osteoarthritis, our glucosamine supply tends to get depleted. You guessed it right: an extra amount of glucosamine supply would make a world of difference to joint health. The reason is simple. Glucosamine helps make cartilage in joints; it is also needed for the formation of blood vessels, bone, ligaments, nails, skin, synovial fluid, and tendons, aside from mucous secretions of our digestive tract. Most importantly, glucosamine is fundamentally needed by our body to make chondroitin.

Chondroitin, or chondroitin sulphate, to use its technical name, is quite like glucosamine — it is made within the body, and is also an essential component of cartilage and other connective tissues. It belongs to a group of compounds called glycosaminoglycans.

Results of clinical trials and research data on human patients have been consistent — that glucosamine and chondroitin relieve joint pain, improve mobility, reduce swelling in the affected part, and also our dependence on non-steroidal anti-inflammatory drugs [NSAIDs], such as aspirin, which have unpleasant side-effects.

What’s more, several clinical and patient studies have also shown that glucosamine and chondroitin significantly reduce pain and stiffness. This relief, as experts suggest, is better than or equal to ibuprofen, another well-known NSAID, and also without dangerous side-effects.

There is clinical evidence too that glucosamine maintains the individual’s joint space while increasing its function and flexibility.

Glucosamine and chondroitin are both components of normal cartilage; they are available in pharmacies and health food stores, as nutritional, or nutraceutical, supplements, without a prescription. The supplements are well tolerated and safe. Also, because the duo stimulates the production of new cartilage components, studies suggest that the two supplements are also able to help the body repair damaged cartilage, leading to long-lasting comfort from joint pain.

Speak to your physician, and find out why it is good enough reason to try them — and, derive their health benefits. Naturally.